Image: Surgeons Gonzalo Vitagliano, Javier Salazar and Ezequiel Muiño Aguilar using biomodels in surgery.
There is a lot of talk about 3D printing or additive manufacturing in medicine. The usefulness of this technology to simplify anatomical understanding in complex cases is clear.
It allows us to "hold in our hands", on a real scale, in three dimensions, all the anatomical information of the patient prior to surgery. It is the evolution to visualising on a 2D screen the images of resonance, tomography or similar studies.
However, it is sometimes not clear to healthcare professionals when and why to use 3D models. Here you will find a quick guide with examples according to your speciality:
1. Paediatric Cardiovascular Surgery
In paediatric cardiovascular surgery, 3D printing makes it possible to obtain faithful models of small intracardiac structures and of the relationships between the different vascular structures. They are widely used for multiple pathologies, where the following stand out:
Double outlet right ventricle
Tetralogy of Fallot
Truncus arteriosus
Anomalous pulmonary venous drainage
Transplant evaluation
Biomodels are often used in the first instance to assess the feasibility of surgical treatment, and in the second instance to practice the procedure prior to surgery, as it is possible to manufacture the hearts with flexible resins to train specific techniques.
In the image you can see a biomodel operated by Dr. Pedro Becker Rencoret, at the Clínica UC in Santiago de Chile, where the use of 3D technology simplified the compression of the case and the subsequent surgery.
The implications of using 3D models in paediatric cardiovascular surgery can be enormous. Scientific evidence shows that they generate changes in surgical strategy in more than 40% of cases (I. Valverde et al. 2017) and that they can reduce critical times such as aortic clamping by up to 25min (L. Zhao et al. 2018).
2. Cardiothoracic surgery
In this video you can see the team of Dr. Rodrigo Pacheco Ruiz, using all the options of 3D technologies (physical and virtual) in the operating room in La Paz, Bolivia. It was a thoracic lipoma exeresis. In thoracic surgery, multiple applications of 3D printing stand out:
Firstly, airway pathologies such as complex tracheal stenosis or tracheolaryngeal injuries requiring reconstruction.
Secondly, alterations of the thoracic and mediastinal anatomy are pathologies where 3D biomodels offer great advantages for surgical decision-making. The example in the image is a case of lusory dysphagia performed by Dr Alejandro Bertolotti and team at the Favaloro Foundation.
Finally, oncological cases are the most frequent, where the usefulness of 3D models for planning the resection of mediastinal, bronchial and/or coastal tumours is clear, as they allow to evaluate the relationship of the tumour with all adjacent anatomical structures and consequently define a better surgical approach.
Again, the scientific evidence supports the empirical experience. More than 90% of surgeons who used the technology in the thorax rate it as very useful to improve communication with the patient (Zabaleta et al. 2019) and the correlation between 3D models and intra-surgical findings is highlighted as very high [0.92] (Smelt et al. 2018) corroborating the usefulness of the technology in deciding the most appropriate surgical strategy.
3. Uro-Oncology
The use of 3D biomodels for planning laparoscopic partial nephrectomies is becoming a new standard worldwide.
3D models allow clear visualisation of the entire renal vascular structure and its relationship to the tumour in order to plan a resection with minimal complications and greater preservation of healthy organs.
In these cases, surgical time is reduced, bleeding is reduced and it is easier to explain to the patient and his or her family what the procedure will be like. The doctor can visualise the patient's anatomy in 3D and understand it from all angles: Explore 3D renal visualisation
The images correspond to procedures by Dr. Nicolás Richards, at CEMIC, and Dr. Gonzalo Vitagliano, at the German Hospital in Buenos Aires.
4. Neurosurgery
The image is a biomodel of a skull base tumour, where Dr Javier Salazar, from the Favaloro Foundation, was able to plan and simulate the surgery.
The applications of 3D printing in neurosurgery cover both brain pathologies and those of the spine and spinal cord. They are mainly used in skull base tumours, spinal tumours, trauma and severe scoliosis.
Example of a case performed with Dr. Alfredo Chaves at the Alexander Fleming Institute.
Once again, scientific evidence validates the implementation of 3D printing in neurosurgery: it reduces surgical times by 40 minutes and improves the outcome in 78% of cases (M Izatt et al. 2007).
(*) Applications in Vascular Surgery, BPH, Plastic Surgery and Head and Neck Surgery will be covered in Part 2 of this guide.
Reflection
Applications on bone structures tend to be the best known (which is why they are not discussed in depth in this article). However, there is a huge opportunity to provide better treatments by implementing 3D printing in other areas. Especially oncological, cardiovascular and paediatric surgery.
The transversality of 3D printing in healthcare makes this technology extremely attractive to be incorporated in an integral way in healthcare institutions dedicated to high complexity. This will increase patient safety and reduce costs in terms of operating theatre time and post-operative recovery.
All the cases mentioned above are real examples developed by MIRAI 3D in collaboration with the professionals and institutions mentioned above.
If you wish to test this technology with a real case, I invite you to send us the patient's .DICOM images, anonymised, through the following link: https://mirai3d.wetransfer.com/
Thank you very much, what did you think about this information?
Matias Ezequiel Biancucci
matias@mirai3d.com | www.modelosmedicos.com